Question:
Has anyone had dealings with a company that is self-insured and trying to get approve

I work for a company that is self insured (I work in NC, the company I work for is based in SC), and I am worried about what they will and won't cover. Does anyone know any federal legislation on this subject? Or does anyone know hoe to deal with these situations?    — Pamela P. (posted on August 5, 2001)

August 5, 2001
It's called ERISA. I live in Ohio and my employer is in Michigan. They are also self insured. Can't say much about it because I am in the process of my appeal because we have an exclusion in our policy. I do know that I have to exhaust all steps of the appeal process through UHC before they will take a look at paying for the surgery.
   — K T.

August 5, 2001
I tried for 1 year, and go NO Where w/ self insured. I was told they do not have to answer to to govt. I started in HR dept. they would not change this policy. I appealed and got the answer NO, not even if it's medically neccessary. I called Walter and was about to try w/ him when I landed a new job and their insurance pays for WL surgery. I hope you have better luck than me. I wasted a whole year fighting for nothing.
   — [Anonymous]

August 5, 2001
Hi. I am two months post=op DS Lap and our insurance covered this procedure for me. They are self-funded but of course, administered by a third party, Consolidated Health Plans, out of Louisiana and I live in Florida. Again, it's gonna depend on the exclusions that are part of your plan's benefits. There were NO exclusions for WLS in the "specific case of Morbid obesity" in my plan, hence, with a BMI of 51, I was approved in 3 days. Hope this helps and good luck!!
   — ChristiMNB

August 6, 2001
Hello, I'm dealing with one right now. I don't know where you work but, where I work we have a union very good one too. When I was denied I filed a greivence with the union. Still filled out my appeal letter though. That way if it comes down to it and I do the process correctly the union will pay for the laywer to fight my case. Should find out today if I have to keep fighting or if they will change their mind and cover it. Hope this helps Debbie
   — deborah D.

August 6, 2001
I work for a company that is self insured and I was approved in 10 days. They usually have a 3rd party deal with their claims. If you have any problems and they dont' approve it talk to your HR department. I did that once before when i had to have surgery (not weight related). Good Luck
   — Donna J.

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